Provider Demographics
NPI:1073506291
Name:PROTO, BENJAMIN R (DPM)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:R
Last Name:PROTO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8866
Practice Address - Street 1:860 OMNI BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-327-0657
Practice Address - Fax:757-327-0658
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300835213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073506291Medicaid
VA236542OtherANTHEM PROVIDER NUMBER
VA9304797Medicaid
VA58381OtherOPTIMA PROVIDER NUMBER
VA394596OtherMDIPA/MAMSI PROVIDER NUM
VA1073506291Medicaid
VA236542OtherANTHEM PROVIDER NUMBER
VA58381OtherOPTIMA PROVIDER NUMBER